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Urine Albumin Screening and

Monitoring in Type 2 DM
Albuminuria describes a condition in which urine contains an
abnormal (high) amount of albumin. In people with Type 2
Diabetes (DM), albumin is the primary protein excreted by the
kidneys. Albuminuria is usually a marker of nephropathy and
CVD. High levels and/or a rapid rise in urine albumin may be a
sign of serious kidney disease. Not all kidney disease in people
with diabetes is diabetic nephropathy; consider other causes of
kidney damage.
The gold standard for kidney testing in people
with diabetes = UACR and eGFR

Urine Albumin Tests


1. Urine Albumin: Creatinine Ratio (UACR)
UACR measures Albumin excretion in: mg albumin/g
creatinine.
Run on a spot urine sample; timed samples not necessary.
This test accounts for variation in urine concentration.
Good at assessing any level of proteinuria
Values can be used for screening, diagnosing, and
monitoring interventions, for guiding therapy.
Requires lab analysis; there is currently no POC test.
The gold standard for urine albumin testing = UACR

Assessing Urine Albumin in Type 2 DM


1. Screen: Check UACR at diagnosis and yearly
2. Diagnosis: Positive diagnosis albuminuria if UACR is greater
than 30mg/g on 2 separate occasions
3. Monitor: Recheck UACR every year
More frequent monitoring may be needed in patients with
changing clinical status or after therapeutic interventions.

(Do not monitor urine albumin in dialysis patients)


When you should NOT screen for proteinuria:
Do not screen if symptoms of UTI or a UA that is positive for
leukocytes, nitrite, or RBC. Address these issues first, then
screen for urine protein once resolved
Causes of false positives include: strenuous exercise within 24
hours, infection, fever, CHF, marked hyperglycemia,
pregnancy, marked hypertension, UTI, and hematuria.

Other urine protein tests


These tests are not recommended for assessing albuminuria

2. Urine Protein: Creatinine Ratio (UPCR)


Not sensitive for early detection; not standardized

3. 24 hour urine collection for protein


Labor intensive for patients and is difficult to get a complete and
accurate sample; no more effective than simpler tests such as
UACR for DM nephropathy

4. Test strips (e.g. Micral, Clinitek)


Test strip results may look like UACR results (mg albumin/g
creatinine) but less accurate
Local lab test names vary widely; Talk with your lab on how to order
a UACR (and not a test strip).
CLIA-waived POC test; but trade accuracy for convenience

5. UA dipstick
Only detects higher levels of proteinuria (>300mg/g)
Not precise and cannot be used to assess or monitor albuminuria in
Type 2 Diabetes

Management of Albuminuria
The following strategies should be implemented to reduce
albuminuria, prevent/slow nephropathy progression, and lower
the risk of CVD:
Maximize ACE Inhibitor/ARB
BP Control
Stop smoking
Lipid Control
Protein restriction (later stages) Glucose Control
Repeat UACR to monitor effectiveness of intervention; a
decrease in urine albumin is therapeutically significant.
Developed by the IHS Division of Diabetes Treatment and Prevention - November 2009.

The Diabetes Care and Outcomes Audit will count any type
of urine protein screening, but UACR is preferred
Albuminuria is a continuous variable, the terms microalbuminuria
and macroalbuminuria are going out of use.
Since these terms are still used for ICD9 Coding:
Normal
= < 30mg/g
Microalbuminuria = 30 - 300mg/g
Macroalbuminura = > 300mg/g

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